Medicaid HMOs may need state OK to cut rates

It started after a contracted HMO providing Medicaid managed care services said it planned to cut rates for personal care assistance. Now, a pending bill would prohibit unauthorized provider reimbursement rate decreases by other managed care organizations, as well as Medicaid and NJ FamilyCare.

“Vulnerable patients should not be blindsided with higher healthcare costs,” said State Sen. Robert Singer (R-Monmouth, Ocean), one of the bill's sponsors. “Managed care organizations must explore all other options before seeking to decrease provider benefits via a rigorous public process.” Senate Bill 2241 passed the Senate in late November and was awaiting final approval in the state Assembly.

The rate decrease was sought by Horizon NJ Health, one of the four HMOs contracted to provide Medicaid managed care services. It would have affected home health aides' services for high-needs children and seniors.

While long-term care professionals have at least two more weeks to agonize over the fate of a bill that would permanently repeal the current Medicare physicians funding formula, a host of other key funding "extenders" set to expire also hang in the balance.

Nearly four months into the year, a 2015 calendar sporting nude photographs of the residents of Pleasant Pointe Assisted Living in Akron, OH, are still flying out the door — so much so that a second printing was ordered.